<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

  
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('授权区域')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-address" class="form-control" data-toggle="city-picker" name="row[address]" type="text" value="{$row.address|htmlentities}"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('区域价格')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-price" data-rule="required;range(1~)" class="form-control" name="row[price]" type="number" value="{$row.price|htmlentities}"> 
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('续费价格')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-renewal_price" data-rule="required;range(1~)" class="form-control" name="row[renewal_price]" type="number" value="{$row.renewal_price|htmlentities}"> 
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-num" data-rule="required;range(1~)" min="0" class="form-control" name="row[num]" type="number" value="{$row.num|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
